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DOI: 10.1055/a-2344-7534
A rare case of pancreatic glomangiomyoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration
A 67-year-old woman presented with a 3-month history of upper abdominal pain. No positive result was found in tumor markers and antinuclear antibodies. Magnetic resonance imaging (MRI) detected a 15 × 11-mm mass with a T1W low signal and T2W high signal, which was enhanced in the arterial phase and weakened in the delayed phase. Endoscopic ultrasound (EUS) revealed a 14 × 12-mm hypoechoic lesion with a heterogeneous echo and a few stripe hyperechoic tissues. Ultrasound elastography imaging was primarily dominated by yellow-green tones interspersed with small areas of red and blue hues. Contrast-enhanced ultrasound showed heterogeneous enhancement in the arterial phase that receded quickly in the venous phase. The specimens were obtained by EUS-guided fine needle aspiration (FNA) with a 22G puncture needle of wet suction. Pathological examination revealed round tumor cells with SMA(+), Syn(–), Ki67 (3%+), CD34 (vascular+), consistent with the characteristics of a glomangiomyoma ([Fig. 1]).
Glomangiomyoma is a rare benign tumor of the glomus body, a specialized form of arteriovenous anastomosis. This case demonstrated the first comprehensive diagnosis procedure for pancreas glomangiomyoma by EUS-FNA. Pancreatic glomangioma was only reported by John R Miliauskas et al. in 2002 [1] and Ichiro Tamaki et al. in 2020 [2], which were all diagnosed by surgery. This case showed a well-defined, round-like mass under EUS scanning, and high enhancement under contrast-enhanced ultrasound, similar to neuroendocrine tumors. However, its internal echo was uneven, and under ultrasound elastography imaging, it showed an inhomogeneous soft tissue, whose hardness was lower than most neuroendocrine tumors. Under contrast-enhanced ultrasound, it showed an uneven high enhancement different from the uniform high enhancement of most neuroendocrine tumors. These characteristics might be helpful in differentiating pancreatic hemangiomas from neuroendocrine tumors. EUS-FNA is a reliable and practical technique for diagnosing pancreatic glomus tumors ([Video 1]).
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 John RM, Chris W, Philip WA. Glomangiomyoma (glomus tumour) of the pancreas: a case report. Pathology 2002; 34: 193-195
- 2 Ichiro T, Yohei H, Hironobu S. et al. Primary pancreatic glomus tumor invading into the superior mesenteric vein: a case report. Surg Case Rep 2020; 6: 279
Correspondence
Publication History
Article published online:
08 July 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 John RM, Chris W, Philip WA. Glomangiomyoma (glomus tumour) of the pancreas: a case report. Pathology 2002; 34: 193-195
- 2 Ichiro T, Yohei H, Hironobu S. et al. Primary pancreatic glomus tumor invading into the superior mesenteric vein: a case report. Surg Case Rep 2020; 6: 279